Association between anthropometry and cardiovascular risk in patients attending a diabetic clinic

Background Obesity is a well-documented risk factor for cardiovascular disease (CVD) in type 2 diabetes mellitus (T2DM), with increasing evidence to suggest visceral adiposity as a greater risk factor for CVD than body mass index (BMI). Objectives To determine a relationship between hypertension (HPT) and anthropometry in people living with diabetes (PLWD) in an HIV endemic area. Methods This was a retrospective study analysing data captured from standardised clinic sheets from the DM clinic at the Harry Gwala Regional Hospital, Pietermaritzburg, South Africa, from January 1, 2019 to December 31, 2019. Results Data from 957 PLWD were used for the study, the majority of whom had T2DM (811; 86.2%). Approximately one-sixth of the cohort had HIV infection (146; 15.3%). There was no significant difference in HPT prevalence between the HIV-uninfected (77.9%) and PLWD who had HIV (PLWDHIV) (78.1%). Multivariate analysis revealed females with increased waist circumference (WC) and waist-to-height ratio (WTHR) were 57.8 (95% CI 3.04­1096.33) (p = 0.007) and 87.2 (95% CI 4.88­1558.28) (p = 0.002) times more likely to be hypertensive respectively. By contrast, only BMI in males was associated with HPT with a AOR 5.294 (95% CI 1.54 - 18.22) (p = 0.008). HIV status was non-contributory to anthropometry in predicting HPT in PLWD. Conclusion Our study found that anthropometric indices are not all equal predictors of HPT. The authors advocate for local guidance on gender-specific cut-offs on anthropometry in PLWD.

Diagnostic outcomes of bone marrow aspirate and trephine biopsies performed at a hospital in KwaZulu-Natal, South Africa

Background: Bone marrow aspiration and trephine biopsy (BMAT) are widely performed in adults to evaluate haematological and malignant conditions. However, the diagnostic yield from the procedure in unselected patients in the South African public sector has not previously been described. Objectives: We identified the main indications and most common diagnoses encountered for BMAT and described the demographic and blood profiles of patients, including HIV-positive patients, who had undergone the procedure at a tertiary hospital in KwaZulu-Natal.Methods: We retrospectively reviewed laboratory data from January 2016 to December 2016n for all patients aged ≥ 13 years who underwent the procedure and stratified findings by demographic data.Results: Among 120 BMAT biopsies studied, 80 (67%) cases were performed to evaluate suspected malignancy and a further 40 (33%) cases for non-malignant indications. The main indications for bone marrow examination were: cytopenias 38 (32%), lymphoma 35 (29%), leukaemia 21 (18%), and multiple myeloma 17 (14%). BMAT results revealed that 60 cases (50%) were malignant in origin, 30 cases (25%) were non-malignant and 30 cases (25%) were classified as normal. The common diagnoses were: leukaemia, 24 (20%); multiple myeloma, 16 (13%) and lymphoma, 13 (11%). Cases aged ≥ 50 years were more likely to have a malignant diagnosis (odds ratio: 5.8 (95% confidence interval: 2.2­17.1)bp-value < 0.001). Conclusion: The diagnostic yield of BMAT was high, with significant abnormalities detected in three quarters of cases. Haematological malignancy was the more common diagnosis. Increasing age was associated with an increase in reporting of haematology malignancy

The Burden of Diabetes Mellitus in Kwazulu-Natal' S Public Sector : A Year Perspective

Background: The global increase in the prevalence of diabetes mellitus is most marked in African countries. The District Health Information System (DHIS) is the primary data collection system of the Department of Health in KwaZulu-Natal Province (KZN); South Africa. Data are routinely collected at all public healthcare facilities in the province and are aggregated per facility. Objective: To investigate the distribution; incidence and prevalence of diabetes in the public healthcare sector of KZN. Methods: Data collected by the DHIS for all patients with diabetes in KZN from 1 January 2010 to 31 December 2014 inclusive were analysed. Additional open-source databases were accessed to enable further exploration of the data collected. Results: The study showed that the majority (38.7%) of patients with diabetes on the public sector register were from the district of eThekwini. Positive correlations were found between the prevalence of diabetes; the mortality rate and the number of defaulters (patients with diabetes who did not return for regular treatment). Conclusions: Provincial estimates of the prevalence of diabetes in this study were higher than the known national prevalence. This may be due to the large proportion of Indians in KZN; who have a genetic predisposition to diabetes mellitus. However; allowance must be made for possible inaccurate data collection at source with miscounting of individuals. This study supports the global trend of an association between diabetes and urbanisation and highlights the need for regular diabetes screening and education; particularly in the public healthcare domain